Objectives The aim of this study was to investigate the utility of a comprehensive imaging protocol including echocardiography and cardiac magnetic resonance in the diagnosis and differentiation of hypertensive heart disease and heart failure with preserved ejection fraction (HFpEF).

Background Hypertension is present in up to 90% of patients with HFpEF and is a major etiological component. Despite current recommendations and diagnostic criteria for HFpEF, no noninvasive imaging technique has as yet shown the ability to identify any structural differences between patients with hypertensive heart disease and HFpEF.

Methods We conducted a prospective cross-sectional study of 112 well-characterized patients (62 with HFpEF, 22 with hypertension, and 28 healthy control subjects). All patients underwent cardiopulmonary exercise and biomarker testing and an imaging protocol including echocardiography with speckle-tracking analysis and cardiac magnetic resonance including T₁ mapping pre- and post-contrast.

Results Echocardiographic global longitudinal strain (GLS) and extracellular volume (ECV) measured by cardiac magnetic resonance were the only variables able to independently stratify among the 3 groups of patients. ECV was the best technique for differentiation between hypertensive heart disease and HFpEF (ECV area under the curve: 0.88; GLS area under the curve: 0.78; p < 0.001 for both). Using ECV, an optimal cutoff of 31.2% gave 100% sensitivity and 75% specificity. ECV was significantly higher and GLS was significantly reduced in subjects with reduced exercise capacity (lower peak oxygen consumption and higher minute ventilation–carbon dioxide production) (p < 0.001 for both ECV and GLS).

Conclusions Both GLS and ECV are able to independently discriminate between hypertensive heart disease and HFpEF and identify patients with prognostically significant functional limitation. ECV is the best diagnostic discriminatory marker of HFpEF and could be used as a surrogate endpoint for therapeutic studies.

目的这项研究的目的是研究包括超声心动图和心脏磁共振在内的综合成像方案在高血压心脏病和心力衰竭伴射血分数保留（HFpEF）的诊断和鉴别中的实用性。

背景高血压在HFpEF的患者中高达90％，是主要的病因。尽管目前有针对HFpEF的建议和诊断标准，但无创成像技术尚未显示出识别高血压心脏病和HFpEF患者之间任何结构差异的能力。

方法我们对112例特征明确的患者（62例HFpEF，22例高血压和28例健康对照者）进行了一项前瞻性横断面研究。所有患者均进行了心肺运动和生物标志物测试，并进行了包括超声心动图，斑点追踪分析和心脏磁共振在内的影像学方案，其中包括对比前后的T ₁映射。

结果通过心脏磁共振测量的超声心动图总纵向应变（GLS）和细胞外体积（ECV）是能够在3组患者中独立分层的唯一变量。ECV是区分高血压心脏病和HFpEF的最佳技术（曲线下的ECV面积：0.88；曲线下的GLS面积：0.78；两者的p <0.001）。使用ECV，最佳截止值为31.2％，可得到100％的灵敏度和75％的特异性。运动能力下降（峰值耗氧量降低和分钟通气量-二氧化碳生成量增加）的受试者的ECV显着升高，而GLS显着降低（ECV和GLS的p <0.001）。

结论GLS和ECV都能够独立地区分高血压心脏病和HFpEF，并鉴定出预后明显的功能受限的患者。ECV是HFpEF的最佳诊断鉴别标记，可以用作治疗研究的替代终点。